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Jena A, Iqbal M, Baek YS, Lee KN, Rho SY, Shim JM, Choi JI, Kim YH. Unipolar and bipolar electrogram characteristics of recurrent cases of idiopathic ventricular arrhythmias undergoing repeat catheter ablation. Indian Pacing Electrophysiol J 2021; 22:12-16. [PMID: 34823016 PMCID: PMC8811281 DOI: 10.1016/j.ipej.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/02/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Activation mapping guided catheter ablation (CA) of ventricular arrhythmias (VAs) is limited in some cases when it is only relied on bipolar electrogram (EGM). We hypothesized that activation mapping with use of combined bipolar and unipolar EGM facilitates to identify the focal origin of VAs and results in reduction of recurrence rate of CA of VAs. Methods We analyzed the data of patients undergoing repeat ablations for idiopathic out-flow tract VAs. The EGM of the 1 st and 2 nd ablations were compared for earliest local activation time (LAT), presence of discrete potentials, and polarity reversal, unipolar potential morphology (QS or non-QS), potential amplitude and activation slope. Results Thirty-seven patients were included. The Local activation time was significantly earlier in the 2nd ablation as compared to the 1st procedure (36.90 msec vs 31.85 msec, P < 0.01). The incidence of discrete potentials and polarity reversal were similar in both procedures (51% vs 57%, P = 0.8 and 62% in both the occasions, respectively). The unipolar voltage was similar in both occasions (6.94 mV vs 7.22 mV in repeat ablations, P = 0.7). The recurrence rate (5.7%) was significantly lower with routine use of combined unipolar and bipolar EGMs, as compared to the use of bipolar EGM alone (16.7%) Conclusions Use of both bipolar and unipolar electrograms helps in better delineation of the sites of earliest activation for effective ablation of VAs. Use of unipolar electrograms in addition to bipolar electrograms is associated with lower long term recurrence rate. In patients undergoing redo ablations for idiopathic OTVAs, a slow-rapid initial QS morphology with its earlier timing prior to onset of QRS on unipolar EGM facilitate identification of early activation sites and improves success of CA. Bipolar EGM chracteristics like polarity reversal and presence of discrete potentials have no additive efficacy in redo CA cases. A slow-rapid initial QS morphology with its earlier timing to QRS onset may improve the success of CA in idiopathic OTVAs.
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Affiliation(s)
- Anupam Jena
- Kalinga Institute of Medical Sciences, Republic of Korea
| | - Mohammad Iqbal
- Korea University Medical Center, Seoul, Republic of Korea
| | - Yong-Soo Baek
- Korea University Medical Center, Seoul, Republic of Korea
| | - Kwang-No Lee
- Korea University Medical Center, Seoul, Republic of Korea
| | | | - Jae Min Shim
- Korea University Medical Center, Seoul, Republic of Korea
| | - Joing Il Choi
- Korea University Medical Center, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea.
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Han J, Lee JZ, Padmanabhan D, Naksuk N, Asirvatham SJ, Munger TM, Killu AM, Madhavan M, Xiao P, Zheng LR, Cha YM. Catheter ablation of premature ventricular contractions originating from periprosthetic aortic valve regions. J Cardiovasc Electrophysiol 2020; 32:400-408. [PMID: 33305865 DOI: 10.1111/jce.14836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/29/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the ablation outcomes of premature ventricular contractions (PVCs) that originate from the periprosthetic aortic valve (PPAV) regions of patients with aortic valve replacement (AVR). METHODS AND RESULTS Our study had 11 patients who underwent catheter ablation for PVCs arising from the PPAV regions (bioprosthetic aortic valve, n = 5; mechanical aortic valve, n = 6). The PVC characteristics, procedure characteristics, and efficacy of ablation were compared with the control group (n = 33). At baseline, the PPAV group had a lower left ventricular ejection fraction (mean [SD], 41% [12%] vs. 51% [8%]; p = .002). The rate of acute ablation success was 90.9% in the PPAV group. Ablation sites were identified above the left coronary cusp (LCC) and right coronary cusp commissure (LRCC) in one PVC, below the prosthetic valve in eight PVCs (four below LCC and four below LRCC), and within the distal coronary sinus in two PVCs. The mean procedure time, fluoroscopy time, and radiation in the PPAV group were all significantly greater than those in the control group (all p < .05). However, the number of radiofrequency ablation energy deliveries was not different. The PPAV group had a long-term success rate compared with the control group (72.7% vs. 87.9%, p = .48) and an increase of left ventricular ejection fraction from 43% to 49% after successful PVC ablation at follow-up (p < .001). Echocardiography showed no significant change in valve regurgitation after ablation. No new atrioventricular block occurred. CONCLUSION PVCs arising from PPAV regions can be successfully ablated in patients with prior AVR, without damaging the prosthetic aortic valve and atrioventricular conduction.
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Affiliation(s)
- Jie Han
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Deepak Padmanabhan
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Niyada Naksuk
- Division of Cardiology, Department of Internal Medicine, University of Illinois, Chicago, Illinois, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - PeiLin Xiao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang-Rong Zheng
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Li J, Lin W, Zheng C, Zhang C, Yu J, Lin J. Implication of the distinctive bipolar intracardiac electrograms for ventricular arrhythmias arising from different regions of ventricular outflow tract. Europace 2020; 22:1367-1375. [PMID: 32449935 DOI: 10.1093/europace/euaa116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/23/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To investigate the characteristics of bipolar intracardiac electrograms (bi-EGMs) in target sites of ventricular arrhythmias (VAs) originating from different regions of ventricular outflow tract (VOT). METHODS AND RESULTS Two hundred and seventy patients undergoing first-time ablation for VAs originated from distal great cardiac vein (DGCV), aortic sinus cusps (ASCs), or pulmonary sinus cusps (PSCs) were enrolled in present study. Local intracardiac bipolar recordings on 243 successful sites and 506 attempted but unsuccessful ablation sites were analysed. Specific potentials in bi-EGMs on successful sites were more common compared with unsuccessful sites (76.95%, 187/243 vs. 25.49%, 129/506, P < 0.05). A total of 60.00% (81/135) patients in ASCs group presented a presystolic short-duration fractionated potential, higher than 23.21% (13/56) in DGCV and 23.08% (12/52) in PSCs (all P < 0.05); 44.23% (23/52) patients in PSC group showed a presystolic high-amplitude discrete potential, while 1.79% (1/56) in DGCV and 2.22% (3/135) in ASCs (all P < 0.05); 41.07% (23/56) patients in DGCV group showed bi-EGMs of presystolic long-duration multicomponent fractionated potential, which was significantly higher than 3.85% (2/52) in PSCs and 4.44%(6/135) in ASCs (all P < 0.05). CONCLUSION Distinctive morphology of bi-EGMs during VAs can be found in different regions of VOT, which probably due to changes in the arrangements of myocardial sleeves. Correct identification and better understanding of the distinctive features of these bi-EGMs with regards to the anatomic location was important, the presence of specific potentials may add help in successful ablation.
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Affiliation(s)
- Jia Li
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Weiqian Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Cheng Zheng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Chi Zhang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Jiji Yu
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
| | - Jiafeng Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109 Xueyuan West Road, Lucheng District, Wenzhou 325000, Zhejiang, PR China
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Abstract
Arrhythmias arising from the ventricular outflow tracts are commonly encountered. Although largely benign, they can also present with heart failure and sudden cardiac death. Mapping and ablation of these arrhythmias is commonly performed in the electrophysiology laboratory with a high success rate, but occasionally can prove challenging to abolish. This article discusses the mapping and ablation of outflow tract arrhythmias and the challenges that can be overcome by a systematic approach.
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Affiliation(s)
- Magdi M Saba
- Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK.
| | - Anthony Li
- Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK
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Demir S, Akgun T, Gulsen K, Kup A, Uslu A, Kayan F, Kepez A. Catheter-induced premature ventricular complexes (PVCs) may aid in the determination of optimal timing for clinical PVC ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1573-1578. [PMID: 31696518 DOI: 10.1111/pace.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/16/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs. METHODS Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 1 July 2018 and 1 July 2019 constituted our study population. The time interval between the beginning of the EGM and the beginning of the QRS of each catheter-induced PVC (Cath EGM-ECG) and the time interval between the beginning of the EGM of clinical PVCs at the earliest site and the beginning of the QRS of clinical PVCs (PVC earliest EGM-ECG) were noted for each patient. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG. RESULTS Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG. A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population. CONCLUSION Cath EGM-ECG seems to serve as a reliable guide for finding the optimal timing of the earliest site for successful PVC ablation.
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Affiliation(s)
- Serdar Demir
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Kamil Gulsen
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Kup
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Uslu
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | | | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
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Di C, Wan Z, Tse G, Letsas KP, Liu T, Efremidis M, Li J, Lin W. The V 1-V 3 transition index as a novel electrocardiographic criterion for differentiating left from right ventricular outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2019; 56:37-43. [PMID: 31478158 DOI: 10.1007/s10840-019-00612-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to develop a new electrocardiographic criterion for differentiating the origin of outflow tract ventricular arrhythmias (OT-VAs) with precordial transition in lead V3. METHODS A total of 147 consecutive patients with OT-VAs displaying precordial transition in lead V3 who underwent successful catheter ablation in the right ventricular outflow tract (RVOT) (n = 118) or left ventricular outflow tract (LVOT) (n = 29) were included in this study. The V1-V3 transition index was defined as the sum of S-wave amplitude in lead V1 and V2 during premature ventricular contractions (PVCs) divided by the S-wave amplitude during sinus rhythm (SR), respectively, minus the sum of R-wave amplitude in lead V1, V2, and V3 during PVCs divided by the R-wave amplitude during SR, respectively, i.e., [(SPVC/SSR)V1 + (SPVC/SSR)V2] - [(RPVC/RSR) V1 + (RPVC/RSR)V2 + (RPVC/RSR)V3]. RESULTS The V1-V3 transition index was significantly higher for RVOT origins than for LVOT origins (1.25 ± 2.48 vs. - 3.94 ± 3.11; P < 0.001). Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.931 for the V1-V3 transition index, and a cutoff value of > - 1.60 predicted a RVOT origin with a 93% sensitivity and 86% specificity. With respect to AUC and accuracy, the V1-V3 transition index was superior to any previously proposed ECG indices for differentiating left from right OT-VAs. In 37 prospective cases, the new index was able to predict the site of a RVOT origin with 95% accuracy (35 of 37 cases). CONCLUSIONS The V1-V3 transition index is a useful novel ECG criterion for distinguishing left from right OT-VAs with precordial transition in lead V3.
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Affiliation(s)
- Chengye Di
- First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, People's Republic of China
| | - Zheng Wan
- Cardiovascular Center, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676, Athens, Greece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676, Athens, Greece
| | - Jianming Li
- Department of Cardiovascular Division, Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Wenhua Lin
- First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, People's Republic of China.
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7
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Lee WC, Wu PJ, Fang HY, Chen HC, Chen YL, Tsai TH, Pan KL, Lin YS, Chen MC. Late fractionated potentials in catheter ablation for right ventricular outflow tract ventricular arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1115-1124. [PMID: 31222754 DOI: 10.1111/pace.13748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endocardial late fractionated potentials during sinus rhythm mapping may reflect abnormal "subendocardial" substrates associated with right ventricular outflow tract (RVOT) ventricular arrhythmias (VAs). The aim of this study was to explore the clinical outcomes of catheter ablation guided by these late fractionated potentials for RVOT VAs in patients without structural heart disease. METHODS From January 2016 to March 2018, 28 patients underwent catheter ablation for RVOT premature ventricular contractions (PVCs) or ventricular tachycardia (VT), guided by the EnSite NavX or Velocity V5.0 three-dimensional mapping system (Abbott, St. Paul, MN, USA). Among them, 10 patients (35.7%) were found to have endocardial late fractionated potentials during sinus rhythm mapping (Group 1). Group 2 was composed of 18 patients in whom no endocardial late fractionated potentials were seen. The burden of VAs, acute procedural success, and 3-month clinical outcomes were analyzed. RESULTS The average duration of late fractionated potentials after the end of QRS during sinus rhythm mapping in group 1 was 45.00 ± 17.15 ms. Baseline demographics and morphology and burden of PVCs were similarly distributed between both groups. Group 1 had higher acute procedural success compared to group 2 (100% vs 66.7%; P = .039). Moreover, at 3-month follow-up, group 1 had lower total PVCs (49 (1-5986) versus 4316 (1-23231); P = .048), PVC burden (0% (0-5.9) vs 4.3% (0-18.9); P = .055), and higher clinical success (100% vs 55.6%; P = .025) compared to group 2. CONCLUSION The identification and elimination of endocardial late fractionated potentials during sinus rhythm mapping could improve the acute success and short-term outcomes of ablation for RVOT VAs.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Parreira L, Marinheiro R, Carmo P, Amador P, Mesquita D, Farinha J, Cavaco D, Jeronimo R, Costa F, Adragão P. Isolated diastolic potentials as predictors of success in ablation of right ventricular outflow tract idiopathic premature ventricular contractions. PLoS One 2019; 14:e0211232. [PMID: 30726274 PMCID: PMC6364967 DOI: 10.1371/journal.pone.0211232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Discrete potentials, low voltage and fragmented electrograms, have been previously reported at ablation site, in patients with premature ventricular contractions (PVCs) originating in the right ventricular outflow tract (RVOT). The aim of this study was to review the electrograms at ablation site and assess the presence of diastolic potentials and their association with success. METHODS We retrospectively reviewed the electrograms obtained at the radiofrequency (RF) delivery sites of 48 patients subjected to ablation of RVOT frequent PVCs. We assessed the duration and amplitude of local electrogram, local activation time, and presence of diastolic potentials and fragmented electrograms. RESULTS We reviewed 134 electrograms, median 2 (1-4) per patient. Success was achieved in 40 patients (83%). At successful sites the local activation time was earlier- 54 (-35 to -77) ms vs -26 (-12 to -35) ms, p<0.0001; the local electrogram had lower amplitude 1 (0.45-1.15) vs 1.5 (0.5-2.1) mV, p = 0.006, and longer duration 106 (80-154) vs 74 (60-90) ms, p<0.0001. Diastolic potentials and fragmented electrograms were more frequently present, respectively 76% vs 9%, p <0.0001 and 54% vs 11%, p<0.0001. In univariable analysis these variables were all associated with success. In multivariable analysis only the presence of diastolic potentials [OR 15.5 (95% CI: 3.92-61.2; p<0.0001)], and the value of local activation time [OR 1.11 (95% CI: 1.049-1.172 p<0.0001)], were significantly associated with success. CONCLUSION In this group of patients the presence of diastolic potentials at the ablation site was associated with success.
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Affiliation(s)
- Leonor Parreira
- Arrhythmology Department, Hospital da Luz, Lisboa, Portugal
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Rita Marinheiro
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Pedro Carmo
- Arrhythmology Department, Hospital da Luz, Lisboa, Portugal
| | - Pedro Amador
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Dinis Mesquita
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - José Farinha
- Cardiology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Diogo Cavaco
- Arrhythmology Department, Hospital da Luz, Lisboa, Portugal
| | | | | | - Pedro Adragão
- Arrhythmology Department, Hospital da Luz, Lisboa, Portugal
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Kobayashi Y. Idiopathic Ventricular Premature Contraction and Ventricular Tachycardia: Distribution of the Origin, Diagnostic Algorithm, and Catheter Ablation. J NIPPON MED SCH 2018; 85:87-94. [PMID: 29731502 DOI: 10.1272/jnms.2018_85-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Idiopathic ventricular premature contractions (VPCs), defined as VPCs in the absence of obvious structural heart disease, are one of the common types of arrhythmia in clinical practice. They are sometimes complicated with non-sustained ventricular tachycardia (VT), and/or sustained VT with almost same QRS morphology in 12 leads ECG. Idiopathic VT (IVT) commonly occurs by focal mechanisms and the origins are distributed in a variety of sites in both ventricles. In this article, the clinical characteristics of IVT/IVPCs, the diagnostic algorithm, and how to ablate them will be reviewed.
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Affiliation(s)
- Yoshinori Kobayashi
- From the Department of Internal Medicine, Division of Cardiology, Tokai University Hachioji-hospital
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10
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Moak JP, Sumihara K, Swink J, Hanumanthaiah S, Berul CI. Ablation of the vanishing PVC, facilitated by quantitative morphology-matching software. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1227-1233. [PMID: 28846152 DOI: 10.1111/pace.13186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ablation of cardiac arrhythmias in children and teenagers often necessitates the use of anesthesia, which can suppress ventricular arrhythmias (VAs), making it difficult to map the site of origin using activation time (AT). Pace mapping, a technique employed to assist with VA origin localization, depends on subjective comparison of paced and targeted QRS morphology. We assessed the utility of a quantitative approach to paced QRS to VA morphology matching using the PaSo software (Carto 3, Biosense Webster), to localize the VA site of origin. METHODS Twenty-four patients underwent 26 procedures for frequent VAs, 29 for targeted VA. If AT mapping was precluded due to infrequent VA, pace mapping was executed using the PaSo software, after regionalization based on targeted VA QRS morphology. RESULTS Subjects were aged 1-32 (mean 14 ± 6) years; 10 were male. Heart disease was present in six patients. PVC frequency prior to onset of anesthesia was 15 ± 16/min, decreasing to 0-1 PVC/min in 17 cases prior to ablation. Arrhythmia localization was performed by AT mapping + PaSo (12) or PaSo only (17). Pace mapping exhibited an intraventricular gradient of percent QRS morphology match. Highest achieved QRS match averaged 96 ± 2%. Successful ablation (> 1-month follow-up) was achieved in 24/29 targeted VAs, 11/12 ablated using AT and pace mapping, and 13/17 VA ablated using pace mapping only, P = 0.29. CONCLUSIONS (1) Spontaneous VA frequency was markedly reduced following anesthesia, despite catecholamine administration. (2) Notwithstanding the ability to perform AT mapping, successful ablation can still be performed using pace mapping only, facilitated by the PaSo software.
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Affiliation(s)
- Jeffrey P Moak
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Kohei Sumihara
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Jonathan Swink
- Division of Cardiovascular Anesthesia, Children's National Health System, Washington, DC, USA
| | | | - Charles I Berul
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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11
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Sun H, Lakin R, Yang P. Interpretation of discrete potential in idiopathic outflow tract ventricular arrhythmia: more consideration. Europace 2016; 18:630. [DOI: 10.1093/europace/euv133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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